[Arteriovenous fistula for pediatric hemodialysis. Experience of 9 years]. / Fístulas arteriovenosas para hemodiálisis en niños.

Seventy-eight A-V fistulas were constructed in 45 children whoses age were between 4 to 16 years, in order to use it for chronic hemodialysis. Twenty-four of them were external A-V shunts which were occluded by thrombosis in 13 instances and deinserted in 3 patients. Thirty-six A-V fistulas were performed with saphenous wein autograft between an artery and vein at the forearm. The main complication in this group was thormbosis in 10 instances and dilations of the graft in 5. In 9 patients, latero-lateral arteriovenous anasthomosis was performed. In these, adequate blood flow developed slowly or was poor in most patients. Six patients with saphenous-femoral anasthomosis developed thrombosis in 3 instances and venous puncture was frequently difficult. In three other patients, bovine carotid artery graft was very efficient to give a good access to circulation for hemodialysis. There was no evidence of local or cardiovascular complications associated with fistulas.

[Nutritional evaluation and use of a nutritional complement in children undergoing periodical hemodialysis]. / Valoración nutricional y uso de un complemento alimenticio en niños en hemodiálisis periódica

Six uremic dhildren in periodic hemodialysis with protein-calorie malnutrition were studied. Three of them were given diet supplementation with a compound constituted by carbohydrates and essential amino acids. Evaluation at ,3 and 6 months with somatometry, rutine laboratory analysis, intravenous glucose tolerance test and plasma amino acid determinations, showed that patients with diet supplementation had a slight increase in height and body weight, improved glucose in tolerance, that was initialy detected, and an abnormal pattern of plasma amino acids not modified during the study. Patients without diet supplementation showed no changes in height, body weight, glucose tolerance and plasma amino acids. These results suggest that diet supplementation with carbohydrates and amino acids is useful to improve nutrition in uremic children on hemodialysis, but it is neccesary to study more patients.

[Hemodialysis with low sodium concentration in hypertensive uremic children]. / Hemodiálisis con baja concentración de sodio en niños urémicos hipertensos

In three hypertensive uremic children in whom hypertension was not controlled by sodium-free diet, ultrafiltration and hypotensive drugs, a total of twenty low sodium concentration hemodialyses were carried out. In all patients there was insignificant sodium excretion in urine and diastolic blood pressure diminished 10 to 20 mm Hg; two patients showed also reduction of systolic blood pressure. No important changes were seen in the serum concentrations of sodium, calcium and glucose. In one patient improvement of his retin lesions, as well as radiological reduction of heart size were observed. In other two cases, cardio-respiratory symptoms associated with hypertension disappeared. In all but two of them hypotensive drugs were withdrawn; in the other one dose was reduced. With low sodium concentration hemodialysis, sodium extraction was higher than that obtained when using the conventional dialysis solution. Interchangeable sodium decreased in all patients.